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Clinical Note |

Aryepiglottic Abscess Manifesting as Epiglottitis

Jeremy Reed, MD, MPH; Rahul K. Shah, MD; Barbara Jantausch, MD; Sukgi S. Choi, MD
Arch Otolaryngol Head Neck Surg. 2009;135(9):953-955. doi:10.1001/archotol.127.12.1495.
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Acute epiglottitis is an exceedingly rare, potentially deadly disease. Since the introduction of the Haemophilusinfluenzae type B (HiB) vaccine in the mid-1980s, its incidence has decreased dramatically. With the decrease in the incidence of epiglottitis attributed to HiB came a relative increase in epiglottits caused by other pathogens. These atypical pathogens often present in an atypical manner, confusing the clinical picture and often delaying diagnosis and treatment. As the immunized portion of the population increases, atypical non-HiB epiglottis will become the rule rather than the exception. Successful management of this disease poses a particularly difficult challenge to physicians who have been trained in the post-HiB era, in which epiglottitis is both rare and deceptive in presentation.

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Figure 1.

Preoperative contrast computed tomograms of the patient's neck showing right aryepiglottic fold phlegmon. A, Axial image. B, Sagittal image.

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Figure 2.

Direct laryngoscopy revealing fullness of the right aryepiglottic fold with edematous, inflamed, erythematous epiglottis.

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Figure 3.

Direct laryngoscopy revealing resolved epiglottitis though persistence of fullness in the right aryepiglottic fold, with subsequent needle aspiration of the aryepiglottic fold.

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